A broken finger or finger fracture is a common type of

bone fracture A bone fracture (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a '' ...

, affecting a

finger A finger is a limb of the body and a type of digit, an organ of manipulation and sensation found in the hands of most of the Tetrapods, so also with humans and other primates. Most land vertebrates have five fingers ( Pentadactyly). Chambers ...

. Symptoms may include pain, swelling, tenderness, bruising, deformity and reduced ability to move the finger. Although most finger fractures are easy to treat, failing to deal with a fracture appropriately may result in long-term pain and disability. The cause is usually

traumatic injury An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or o ...

. These are most commonly falls, crushing injuries, and sports injuries.

Pathological fracture A pathologic fracture is a bone fracture caused by weakness of the bone structure that leads to decrease mechanical resistance to normal mechanical loads. This process is most commonly due to osteoporosis, but may also be due to other pathologie ...

s, from an infection or a tumour, are rarer.

Anatomy

Location

Finger fractures are identified by the bone on which they occur. Fingers are numbered 1 to 5, with 1 being the thumb. The distal (tip) finger bones are divided into tuft (the very tip of the bone, at the end of each finger), shaft (the thinner middle section), and base. The rest of the finger bones (the middle finger bones, and the

proximal Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

or innermost finger bones) are divided into base, shaft, and

condyle A condyle (;Entry "condyle"
in
The

AO Foundation The AO Foundation is a nonprofit organization dedicated to improving the care of patients with musculoskeletal injuries or pathologies and their sequelae through research, development, and education of surgeons and operating room personnel. The AO ...

Orthopaedic Trauma Association Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

(AO/OTA) classification generates language-neutral numeric codes for describing broken fingers. They run 78 eaning a fracture of the phalanges of the hand umber-code of the finger, with thumb=1 and the little finger=5 umber-code of phalanx, counting 1 to 3 outwards from the hand umber-code of location on the bone, with 1 being the inner end, 3 the outer, and 2 in-between So, for instance, 78.1.1.1 means a fracture to the thumb's innermost bone, at the inner end (the base of the thumb). A letter can be added to describe the fracture pattern., page 87 of PDF fulltext

Fracture patterns

If the blow that breaks the bone bends it sideways, it will usually cause a

transverse fracture A bone fracture (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a '' ...

, a break across the finger. A force at an angle is likely to produce an oblique fracture, and a twisting force is more likely to cause a

spiral fracture A spiral fracture (a.k.a. torsion fracture) is a bone fracture occurring when torque (a rotating force) is applied along the axis of a bone. Spiral fractures often occur when the body is in motion while one extremity is planted. For example, a spi ...

. Crushing injuries may or may not shatter the bone into multiple pieces, which is called a

comminuted fracture A bone fracture (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a '' ...

. Fractures in the joints are often caused by jammed finger injuries, the hand equivalent of a stubbed toe. If a tendon pulls away the bit of bone to which it is attached (an

avulsion fracture An avulsion fracture is a bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma. This can occur at the ligament by the application of forces external to the body (such as a fall ...

, shown in the image at the top of the page), that will also lead to a fracture in a joint.

Causes

Putting out a hand to break a fall and landing badly can fracture a finger. Crushing injuries may occur when a finger gets shut in a door (most common among children under eight), or in an accident with machinery or a heavy object. A jammed finger (a trauma from a blow on the end of the finger) is often caused by trying to catch a ball and may break the finger. Misusing tools, especially

power tools A power tool is a tool that is actuated by an additional power source and mechanism other than the solely manual labor used with hand tools. The most common types of power tools use electric motors. Internal combustion engines and compressed air ...

, can also break fingers. Occasionally, an infection or tumour can cause a broken finger; this is called a

pathological fracture A pathologic fracture is a bone fracture caused by weakness of the bone structure that leads to decrease mechanical resistance to normal mechanical loads. This process is most commonly due to osteoporosis, but may also be due to other pathologie ...

Signs, symptoms and diagnosis

Symptoms include pain, swelling, deformity, decreased range of motion, and instability. There may be pain when the injury is probed. Sensation is checked to look for

nerve A nerve is an enclosed, cable-like bundle of nerve fibers (called axons) in the peripheral nervous system. A nerve transmits electrical impulses. It is the basic unit of the peripheral nervous system. A nerve provides a common pathway for the e ...

damage, and

capillary refill Capillary refill time (CRT) is defined as the time taken for color to return to an external capillary bed after pressure is applied to cause blanching. It can be measured by holding a hand higher than heart-level and pressing the soft pad of a f ...

for

blood circulation The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...

damage. The hand is also checked for injuries to the soft tissues, like sprains and tendon tears, and for dislocations to the joints, because these may have been caused at the same time.

Complications

Some finger fractures are severe enough to need surgery. In these severe cases, complications often occur, but most eventually heal functionally. Rarely, there are long-term complications, including decreased

range of motion Range of motion (or ROM), is the linear or angular distance that a moving object may normally travel while properly attached to another. It is also called range of travel (or ROT), particularly when talking about mechanical devices and in mechanic ...

and deformity. A break that affects the joint surface may be displaced so that there is a step in the joint surface, which should be smooth. This will hinder motion and risks post-traumatic osteoarthritis, so it is usually reduced (put back in place) surgically. If the fracture is unstable (won't stay reduced), or a joint is

dislocated A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet.Dislocations. Lucile Packard Children’s Hospital at Stanford. Retrieved 3 March 2013 A partial dislocation is refe ...

or partially dislocated, hand surgeons agree it should be surgically repaired. Open fractures, in which the skin is broken, also increase the risk of infection and complications, especially if the wound is dirty or parts have to be removed. Open fractures are usually operated on. A Busch fracture is a specific type of finger fracture where the base of a distal phalanx is affected. Without adequate treatment, it can become a mallet finger.

Treatment

Broken fingers are treated in

emergency An emergency is an urgent, unexpected, and usually dangerous situation that poses an immediate risk to health, life, property, or environment and requires immediate action. Most emergencies require urgent intervention to prevent a worsening ...

if the broken finger is

blue Blue is one of the three primary colours in the RYB colour model (traditional colour theory), as well as in the RGB (additive) colour model. It lies between violet and cyan on the spectrum of visible light. The eye perceives blue when obs ...

or numb, if the fracture is displaced (the finger is at an angle to where it should be), or if bone is visible in or through the wound.

Extraction

If a broken finger is trapped in an object, it must be freed in a way that avoids further injury. Relaxation, elevation, icing, and lubrication (e.g. soapy water or oil) may suffice. If not, removal by other methods can be done by a doctor; if the object is not portable, it is often done by

paramedic A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research. Not all ambulance personnel are p ...

s or the

fire department A fire department (American English) or fire brigade (Commonwealth English), also known as a fire authority, fire district, fire and rescue, or fire service in some areas, is an organization that provides fire prevention and fire suppression se ...

. As with other hand injures, any rings or bracelets are removed immediately, before the injury starts to swell. Pulling rings off forcefully may worsen the swelling. Relaxation, elevation, icing, lubrication, and rotating the ring as if unscrewing it may help. If these methods don't work, it may be possible to remove the ring by temporarily wrapping the finger with a slick string (something like dental floss), passing the inner end of the thread under the ring, and then unwrapping it, pushing the ring ahead of the unwrapping string. Failing that, a doctor may remove it by other methods.

Splinting

A broken finger may or may not require surgery. In simple cases, the bone may be put back in place and the finger may then be put in a splint, or strapped to another finger ("

buddy taping Buddy wrapping, also called neighbour strapping or buddy taping, is the act of bandaging a damaged or particularly a fractured finger or toe together with a healthy, uninjured one. The bandage or medical tape is usually stiff, not allowing the ...

"). If the wrap that splints the finger is too tight, there is a risk of

compartment syndrome Compartment syndrome is a condition in which increased pressure within one of the body's anatomical compartments results in insufficient blood supply to tissue within that space. There are two main types: acute and chronic. Compartments of the ...

. If the finger is numb, tingling, more painful, more swollen, or if the skin below the wrap is cool to the touch, the wrap may need loosening. The splint needs to be kept dry and may interfere with daily tasks, which will need to be done by someone else.

Re-alignment

Many finger fractures are not displaced. Simple displaced fractures may be re-aligned (reduced) with a local anesthetic. Surgery may be needed for an unstable fracture (one that won't stay in the right place once reduced), a finger broken in multiple places, a fracture that extends into the joint between the broken bone and another bone, and a fracture with damaged tendon function or damaged nerves.

Pain reduction

Rest, ice, and elevation can be used to reduce pain. Icing is done for 15 to 20 minutes every 2 to 3 hours, or 10–20 minutes every 1–2 hours. Ice isn't placed directly on the skin, but wrapped first, in thin cloth such as a teatowel. Icing is done while awake, for the first three days or until the swelling goes down. Elevation can be done by resting the hand upon a cushion or pillow, and trying to keep it above the heart as much as reasonably possible. An over-the-counter painkiller like

paracetamol Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol. At a standard dose, paracetamol only slightly decreases body temperature; it is inferior ...

ibuprofen Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used for treating pain, fever, and inflammation. This includes painful menstrual periods, migraines, and rheumatoid arthritis. It may also be used to close a patent ductus arte ...

can also be used, but ibuprofen should not be taken before a doctor has diagnosed the fracture.

Prognosis

Broken fingers and thumbs usually heal in 2–8 weeks, with 3–4 months for full strength. Fingers mostly heal well in 3–4 weeks. Eating healthily and not smoking can speed healing. Pain should steadily decrease, with improvements starting within a few days of the injury. If it does not steadily improve, or if tingling, weakness, numbness, or signs of infection appear, it needs further treatment; see complications, above.

Epidemiology

Broken fingers affect 0.012% of people per year in the United States. Finger fractures are common in children and old adults, but less common in the 45 to 85 age range. More male children break their fingers; in adults, only slightly more males. Wealthier people are less likely to break their fingers. The proximal (wristwards) finger bones are those most likely to be broken, and the smaller fingers are more likely to be broken than the index finger and thumb.

Prevention

Prevention includes using protective equipment, avoiding unsafe use of tools and machinery, safety closers to avoid children's fingers being caught in slammed doors, and

fall prevention Fall prevention includes any action taken to help reduce the number of accidental falls suffered by susceptible individuals, such as the elderly (idiopathic) and people with neurological (Parkinson's, Multiple sclerosis, stroke survivors, Guilla ...

. In sports, prevention includes gloves and avoiding high-hand-risk situations.

References

{{Fractures Bone fractures